Faculty:

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2019, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

CLINICAL ACTIONS:

Prior to initiating gender-affirming treatment, the diagnosis of gender dysphoria should be made by a mental health professional skilled in the area. Individuals must be capable of understanding both benefits and risks of treatments as well as implications for future fertility. If a decision is made to proceed, the following is recommended

Role change and hormone treatment should be deferred until puberty

Puberty suppression with GnRH agonists should be initiated when girls and boys begin puberty but no earlier than Tanner Stage 2

Pubertal development of the opposite sex should be initiated around age 16 using the following hormonal medications

Definitive surgery for gender affirmation should be deferred until at least age 18

Clinical and laboratory monitoring every 3 months for the first year, then annually or biannually

SYNOPSIS:

Care of the transgender patient requires a safe and sensitive clinical environment, including gender-neutral forms, brochures and information for sexual minorities, and use of open-ended questions about a patient’s gender identity, sexual orientation, transition and therapy. Use of estrogen in the transgender female increases risk of thromboembolism, macroprolactinoma, liver dysfunction, breast cancer, coronary artery and cerebrovascular disease. Use of testosterone in the transgender male increases risk of breast/uterine cancer, erythrocytosis and liver dysfunction.

KEY POINTS:

Adolescents may need parental consent for treatment even in states that allow emancipated minor status for behavioral health, STI treatment and contraception

Once initiated, cross-sex hormone levels should be maintained in the physiologic range of the appropriate gender

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

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